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Overuse, which is defined as the provision of medical services that are more likely to cause harm than good, is a pervasive problem. Direct measurement of overuse through documentation of delivery of inappropriate services is challenging given the difficulty of defining appropriate care for patients with individual preferences and needs; overuse can also be measured indirectly through examination of unwarranted geographical variations in prevalence of procedures and care intensity. Despite the challenges, the high prevalence of overuse is well documented in high-income countries across a wide range of services and is increasingly recognised in low-income countries. Overuse of unneeded services can harm patients physically and psychologically, and can harm health systems by wasting resources and deflecting investments in both public health and social spending, which is known to contribute to health. Although harms from overuse have not been well quantified and trends have not been well described, overuse is likely to be increasing worldwide.

The way forward, argues Heath, relies on our capacity to rediscover courage and stoicism and to realign the relationship between economic, political, and professional interests.

Years ago, when, for the first time, I heard of the suicide of a patient for whom I was responsible, I thought back to a story I learnt in primary school which had somehow become my personal benchmark for an intractable and unremitting sense of failure. Books are possibilities. Both Haig and Dowrick understand that great writers possess a genius for choosing and using words that throw light on aspects of human experience that the rest of us sense, but are unable to articulate or really understand.

Slowly, inexorably the optimism evaporated within: … a demoralised institutional culture that is clinging to the false comfort of rigidly following bureaucratic guidelines while losing the capacity to think independently, to assert that mental health services are different, and to advocate on behalf of its patients. A huge amount of energy is focused on keeping patients out of the system: devising exclusion criteria to restrict access; limiting clinical engagement by restricting length of sessions and duration of contact; and endlessly driving bed numbers down even further. [...]few of those with severe mental illness have ever been given the attention they need, least of all by mental health services and those, like Penelope Campling, who try to do this are hemmed in and systematically undermined by the way services are structured and delivered.

Iona Heath argues for a rebalancing of the two sides in every clinical consultation, championing that for which evidence based medicine has no answers

Cochrane joins the fight against waste, corruption, and futility in healthcare

Iona Heath argues that doctors and patients need to face up to their fears of uncertainty and death if we are to control overmedicalisation

Many changes to the NHS in its first 70 years have been for the better. But not all change is good, writes Iona Heath, pointing out the aspects of the health service that should be preserved

As doctors, we see every working day the pervasive effects of different forms of structural violence and discrimination that undermine the hopes and aspirations of those on the losing side. This leads to powerlessness, fear and anger. Anger is not only forward facing but also directed toward, systems, institutions, governments—rather than individuals. At its best it is a protest against the status quo. We point out that leadership is one of the core values of our professionalism. In the light of what we see and hear, we have a responsibility to use the anger that this engenders within us to speak truth to power: this speaking is leadership. Our message is: feel the fear and the anger, use it to change the world, and enfold leadership in hope and the pursuit of justice.